Nigeria Is Spared the Worst of AIDS, but Experts Wonder for How Long

By KENNETH B. NOBLE

Published: November 18, 1990

CALABAR, Nigeria—
After a long delay that may have lulled Nigerians into a false sense of security, AIDS has begun to creep into the population, especially among prostitutes, prompting warnings that the disease may soon reach the epidemic levels reported elsewhere in sub-Saharan Africa.

The number of cases officially reported so far in Nigeria is small: Out of a population of about 120 million, only 68 people had been diagnosed as suffering from AIDS through the end of September, according to figures from Nigeria's Health Ministry. While the data are far from complete and almost certainly represent an undercount, several independent studies have similarly found a remarkably low rate of the disease.

Why infection rates in this West African country have lagged behind those of much of the rest of the continent is one of the great mysteries of Africa's AIDS epidemic. The answers, scientists say, could provide clues to prevention of the disease in the future.

Many experts now believe the disease has simply been late in reaching Nigeria, perhaps because of geography, or even chance. Others wonder whether a combination of social and medical factors could spare the country from a runaway epidemic.

But there are already signs that AIDS is spreading here, at least among those at highest risk. An extensive continuing survey of prostitutes in Lagos, Nigeria's capital and largest city, recently found about 14 percent to be infected with the AIDS virus. That means they can spread the virus to others during sexual intercourse and will almost certainly develop the deadly disease in the years to come. Other African Lands Fare Much Worse

Similar surveys of prostitutes in Maidurguri, a northern Nigerian city, found infection rates of 0.2 percent in 1987 and 2.4 percent in 1988, still a relatively low figure but a sign that the rate of infection is rising rapidly. In other African countries, an increasing rate of infection among prostitutes has heralded the relentless spread of the AIDS virus into the general population.

"Fortunately for now, those figures are based on the high-risk group," said Dr. Abi Dada, an epidemiologist who directed the Lagos survey, which is financed by the National Institutes of Health in Washington. "But who can say it will remain there?"

The infection rate among Nigerian adults is generally believed to be well below 1 percent, a tiny percentage when compared with rates of infection in many other parts of Africa.

In Uganda, one of the countries hardest hit, the Government estimates that one million people, or roughly 6 percent of the population of 16 million, are infected with the virus, including more than one in five adults in the capital, Kampala. In several other cities of Central Africa, the virus may be carried by 20 percent or more of all sexually active adults.

In the Ivory Coast, a West African country with one-tenth of Nigeria's population, about 10 percent of adults in the capital, Abidjan, and 5 percent of adults in rural areas are believed to be infected with the AIDS virus.

Thoughout Africa, AIDS has spread mainly through heterosexual intercourse, abetted in many cities by widespread extramarital sex and prostitution and by high rates of venereal diseases that facilitate sexual transmission of the virus.

Despite Nigeria's low figures, something akin to panic has surfaced among scientists and health workers here, who say it may only be a matter of time before the AIDS virus becomes entrenched in the country. The Apathy Worries Nigeria's Doctors

Doctors here are warning against what they describe as a dangerous complacency. The relatively low infection rates, they say, may have encouraged a false belief that the epidemic has been halted at Nigeria's borders.

"There's still a widespread feeling in Nigeria that AIDS is a white man's disease, that it is a disease of foreigners, and that the calamity that has struck the rest of Africa won't happen here," said Dr. Bekki Johnson, a public health specialist and the regional representative for Africare, a Washington-based relief organization.

That assessment was shared by Pearl Nwashili, the director of Stop AIDS, an information program based in Lagos and financed by the Ford Foundation.

"There is a great deal of denial and apathy here," Ms. Nwashili said. "When the epidemic finally hits -- and it will, believe me -- what we've seen in other parts of Africa will be small compared to the devastation here."

In the meantime, many health workers complain that the Nigerian Government has been slow to develop a long-term plan to combat AIDS, although public awareness of the disease is rudimentary at best.

Researchers in Lagos polled 500 girls and women between the ages of 10 and 31 at schools this year to measure their awareness of AIDS. Although 98.5 percent had heard of the disease, 70 percent said they viewed it as a disease of foreigners and 40 percent believed that it did not exist in Nigeria.

Despite the danger posed by transfusions of unscreened blood, less than 5 percent of donated blood is being tested for the virus, said Dr. Edugie Abebe, the national coordinator for the Nigerian Health Ministry's AIDS prevention campaign.